Chapters 4, 6, 7, 8, 19 – Flashcards
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Which example best illustrates the World Health Organization's definition of health? A) 72-year-old woman with well-managed diabetes who walks 2 miles every day and takes classes at the local community college B) 20-year-old man with no significant history of disease who smokes, works a stressful job, and is sedentary C) 50-year-old woman with no health complaints who is alcoholic, lives alone with little social contact, and is obese D) 98-year-old man with dementia who resides in an assisted living facility
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A) 72-year-old woman with well-managed diabetes who walks 2 miles every day and takes classes at the local community college ans: A Feedback: The World Health Organization defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." Although the 72-year-old woman has diabetes, she is managing it well, is physically active, and is effectively developing her mental and social well-being. The 20-year-old man and 50-year-old woman, although they have no known health concerns, do not have healthy lifestyles. The 98-year-old man has a mental condition and there are no indicators of physical or social well-being.
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The nurse collects specific data related to risk factors, health indicators, and health outcomes that determine the burden of disease. Which data would the measure known as HALE yield about health indicators and outcomes? A) Average number of years a newborn is expected to live if current mortality rates continue to apply B) Average number of years that a person can expect to live in "full health" by taking into account years lived in less than full health due to disease and/or injury C) Quantifying the burden of disease to a healthy life on the basis of the loss of years related to the burden of disease. The gap in years reflects the current state of health compared with an optimum state of health of a nation. D) Quantifying the burden of acute illness to a healthy life on the basis of the loss of years related to the burden of acute illness. The gap in years reflects the current state of health compared with an optimum state of health of a nation.
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B) Average number of years that a person can expect to live in "full health" by taking into account years lived in less than full health due to disease and/or injury Ans: B Feedback: Health-adjusted life expectancy at birth (HALE) is the average number of years that a person can expect to live in "full health" by taking into account years lived in less than full health due to disease and/or injury. Life expectancy at birth is the average number of years a newborn is expected to live if current mortality rates continue to apply. Disability-adjusted life years (DALY) is a measure that quantifies the burden of disease to a healthy life on the basis of the loss of years related to the burden of disease. The gap in years reflects the current state of health compared with an optimum state of health of a nation. Acute illness is not a factor in determining health indicators.
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3. The nurse prepares a presentation about the World Health Organization's World Health Statistics Report for 2013. Which trend is mentioned in this report? A) Children in low-income countries are 2 times more likely to die before reaching the age of 5 years than children in high-income countries. B) Every day 800 women die due to complications of pregnancy and childbirth. C) Zimbabwe now has a higher life expectancy than 7 out of 10 countries in Eastern Europe. D) Almost 5% of the world's adult population has diabetes.
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B) Every day 800 women die due to complications of pregnancy and childbirth. Ans: B Feedback: The report includes the following statistics. Every day, about 800 women die due to complications of pregnancy and childbirth. Children in low-income countries are 16 times more likely (not 2 times more likely) to die before reaching the age of 5 years than children in high-income countries. China, not Zimbabwe, now has a higher life expectancy at birth than 7 out of 10 countries in Eastern Europe. Almost 10%, not 5%, of the world's adult population has diabetes, measured by elevated fasting blood glucose (126 mg/dL).
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Which risk factor for poor health is associated with low- and middle-income countries? (Select all that apply.) A) Burning of wood and dung for cooking and heat B) Low status of women C) Sedentary lifestyle D) Not wrapping an infant immediately after birth E) Overconsumption of fatty foods
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A) Burning of wood and dung for cooking and heat B) Low status of women D) Not wrapping an infant immediately after birth Ans: A, B, D Feedback: Low- and middle-income countries have an increased burden of the risk factor of poverty. Extreme poverty—the inability to meet the basic needs of adequate nutrition, safe drinking water, basic education, and primary health services and the lack of a livelihood that can generate the means to secure these basic needs—is the driving force behind increased mortality. The continuous smoke from the burning of air-polluting solid fuels affects the population's health and in turn affects economic prospects. The continued low status of women, despite years of policy development, increases the risk of disease and disability. Interventions to improve neonatal care at birth in lower-income countries include drying the infant off and wrapping immediately after birth. A sedentary lifestyle and overconsumption of fatty foods are not risk factors associated with low- and middle-income countries but with higher-income countries.
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The nurse is assigned to prepare the yearly goals for the community health agency in a developing nation. Which goals, on the basis of the United Nations' Millennium Development Goals for improving global health, should the nurse include? (Select all that apply.) A) Initiate an afterschool sports program at every school in the nation to increase physical activity among children. B) Distribute a mosquito bed net to every home in the nation. C) Provide 1 million free allergy shots to people at highest risk. D) Increase the number of girls who attend primary schools by 100%. E) Provide training on prevention of postpartum hemorrhage to all healthcare workers.
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B) Distribute a mosquito bed net to every home in the nation. D) Increase the number of girls who attend primary schools by 100%. E) Provide training on prevention of postpartum hemorrhage to all healthcare workers. Ans: B, D, E Feedback: The United Nations Millennium Development Goals and Targets include the following: eradicate extreme hunger and poverty; achieve universal primary education; promote gender equality and empower women; reduce child mortality; improve maternal health; halt and reverse the spread of HIV/AIDS, malaria, and other diseases; ensure environmental sustainability; and develop a global partnership for development. Increasing physical activity among children and allergy prevention are not among the United Nations' Millennium Development Goals for improving global health.
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The community health nurse works in a low-income country. The nurse's primary concern is to decrease the incidence of malaria. Which intervention should the nurse pursue? A) Fuel alternatives to burning wood and dung B) Sanitized drinking water C) Education regarding contraception use D) Distribution of and education on the daily use of insecticide-treated bed nets
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D) Distribution of and education on the daily use of insecticide-treated bed nets Ans: D Feedback: Educating families on the daily use of insecticide-treated bed nets in regions where malaria is highly endemic would be the appropriate intervention, as malaria is spread predominantly by mosquitoes. Malaria is not related to burning wood or dung, water quality, or sexual intercourse.
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Which key factors contribute to the rise of noncommunicable diseases in low- and middle-income countries? (Select all that apply.) A) Tobacco use B) Insufficient physical activity C) Unclean water D) High blood pressure E) Lack of contraceptive use
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A) Tobacco use B) Insufficient physical activity D) High blood pressure Ans: A, B, D Feedback: Key factors in the rise of noncommunicable diseases include the following: tobacco use, insufficient physical activity, harmful use of alcohol, unhealthy diet, high blood pressure, overweight and obesity, high cholesterol, and cancer-associated infections. Unclean water and lack of contraceptive use are risk factors for communicable diseases, such as Legionnaires' disease and HIV, respectively.
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The parish community health nurse is assigned to prepare the goals for a 6-month mission trip to a developing nation. Which challenge to the Millennium Development Goals should the nurse consider? A) Child mortality has increased 21% since 1990. B) The percentage of people living on less than $0.25 a day rose from 22% in 1990 to 47% in 2010. C) The number of children out of school worldwide increased from 57 million to 102 million. D) 870 million people still do not consume enough food to meet their nutritional energy requirements.
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D) 870 million people still do not consume enough food to meet their nutritional energy requirements. Ans: D Feedback: 870 million people still do not consume enough food to meet their nutritional energy requirements. Child mortality has dropped 41% since 1990, not increased 21%. Extreme poverty is falling in every region. The percentage of people living on less than $.25 a day fell from 47% in 1990 to 22% in 2010. The number of children out of school worldwide decreased from 102 million to 57 million.
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Which is the focus of Smith's eudaimonistic model? A) Elimination of disease or symptoms B) A fit between people and social roles C) Adaptation to the environment D) Actualization or realization of human potential
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D) Actualization or realization of human potential Ans: D Feedback: The focus of the eudaimonistic model is the actualization or realization of human potential. The focus of the clinical model is elimination of disease or symptoms. The focus of the role performance model is a fit between people and social roles. The focus of the adaptive model is adaptation to the environment.
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Which exemplify determinants of health? (Select all that apply.) A) Living in a community with clean, fluoridated water B) Having a death rate of 500 per 100,000 population C) Living in neighborhood with a high crime rate D) Smoking two packs of cigarettes per day E) Having an infant mortality rate of 95 deaths per 1,000 live births
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A) Living in a community with clean, fluoridated water C) Living in neighborhood with a high crime rate D) Smoking two packs of cigarettes per day Ans: A, C, D Feedback: Determinants of health are factors that affect outcomes of health status, such as physical environment (living in a community with clean, fluoridated water), social environment (living in a neighborhood with a high crime rate), health behaviors (smoking two packs of cigarettes per day), and individual health, as well as broader factors such as access to health services and overall health policies and interventions. Mortality rates are indicators of health, not determinants of health.
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The nurse works to identify epidemiologic transitions in the community. Which exemplifies an epidemiologic transition? A) High fertility and high mortality, resulting in slow population growth B) Improvement in hygiene and nutrition, leading to a decreased burden of infectious disease C) High and fluctuating mortality, due to poor health, epidemics, and famine D) Mortality declines and, later, fertility declines
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C) High and fluctuating mortality, due to poor health, epidemics, and famine Ans: C Feedback: An example of an epidemiologic transition is high and fluctuating mortality, due to poor health, epidemics, and famine. Demographic transitions may progress from low to high levels and include the following: high fertility and high mortality, resulting in slow population growth; improvement in hygiene and nutrition, leading to a decreased burden of infectious disease; mortality declines and, later, fertility declines.
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Which risk factor is associated with overall health? A) Allergy B) Traumatic injury C) Air pollution D) Down syndrome
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C) Air pollution Ans: C Feedback: Risk factor categories found to be associated with overall health include childhood and maternal undernutrition; other nutrition-related risk factors and inactivity; additive substances; sexual and reproductive health; and environmental risks (such as air pollution). Allergy, traumatic injury, and Down syndrome are not risk factors for overall health.
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The nurse recently learned that more than 100 infants and children in the community have received vaccinations at the health clinic in the past month. These data are an example of which health indicator? A) Morbidity and mortality B) Risk factors C) Health service coverage D) Health system resources
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C) Health service coverage Ans: C Feedback: According to the World Health Organization statistical information system, health indicators may be placed into four categories: morbidity and mortality, risk factors, health service coverage, and health system resources. Health service coverage data identify uptake of specific services known to improve or promote health and well-being, such as reproductive health services, infant and child health and immunization, HIV, and tuberculosis care. Morbidity and mortality are measured by life expectancy at birth and health-adjusted life expectancy at birth. Risk factors focus on nutrition and health behaviors and environmental factors such as clean drinking water and burning of solid fuels. Health system resources focus on the capacity and supply of healthcare providers.
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A community health nurse visits a village in Chad. The nurse has just finished assessing a 10-year-old girl who reports always being hungry. She lives in a home with her mother and father, who both work. She says she's never been to a healthcare provider before. Which level of poverty should the nurse most suspect in this girl and her family? A) Middle B) Moderate C) Relative D) Extreme
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D) Extreme Ans: D Feedback: Unlike the moderately and relatively poor, the extremely poor cannot access healthcare and are chronically hungry. "Middle" is not a level of poverty.
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The community health nurse manager works to identify how to manage the local health workforce shortage effectively. Using knowledge of the World Health Organization's (WHO) recommendations, which suggestion should the nurse manager give to the agency? A) Increase the agency's investment in the education and training of new healthcare workers B) Offer incentives to attract workers to thriving urban areas C) Attract men to the health professions D) Provide cures for common health problems to reduce demand for health services
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A) Increase the agency's investment in the education and training of new healthcare workers Ans: A Feedback: WHO considers the following as important requirements for the effective management of health workforce shortages: increased investment in education and training; career incentives to attract health workers to rural and disadvantaged areas; attracting women to health professions and addressing retirement; and health promotion and prevention strategies to reduce demand for health services.
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The nurse manager at a healthcare facility in a developing nation regularly loses nurses to positions in developed nations. According to the World Health Organization, which action would be appropriate for the nurse manger to take to address this problem? A) Lobby for local legislation that prevents migration of healthcare workers. B) Encourage the facility to build workforce capacity within the country. C) Institute HIV prevention measures and treatment for health workers. D) Treat expatriate workers with the same dignity and respect as all healthcare workers.
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C) Institute HIV prevention measures and treatment for health workers. Ans: C Feedback: HIV protection and treatment, as well as plans for emergency preparedness, are paramount if workers are to feel safe in their environments. Migration is a human right, so lobbying for antimigration legislation would not be appropriate. Because the facility is losing its native healthcare workers, not gaining expatriate workers from other nations, encouraging the facility to build workforce capacity in the nurse's own country, and treating expatriate workers with dignity would not address the problem.
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In a healthcare facility, a client is regarded as being healthy if he or she has no diagnosed diseases and is free of any symptoms. Which model of health is in place at this facility? A) Clinical model B) Role performance model C) Adaptive model D) Eudaimonistic model
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A) Clinical mode Ans: A Feedback: The clinical model of health focuses on the elimination of disease or symptoms. For example, some people feel that they are well when they have no symptoms or diagnosed diseases and would not classify themselves as sick otherwise. The role performance model holds that health involves a fit between people and social roles. In the adaptive model, health involves adaptation to the environment. The eudaimonistic model of health holds that health is the actualization or realization of human potential.
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A client reluctantly came to the clinic only after his daughter insisted that he do so. The nurse finds that he has type 2 diabetes. When the nurse explains that he has a serious condition, the client brushes it off and says, "I can still work and provide for my family. I'm not sick." Which model of health has this client adopted? A) Clinical model B) Role performance model C) Adaptive model D) Eudaimonistic model
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B) Role performance model Ans: B Feedback: The role performance model holds that health involves a fit between people and social roles. For example, some people, even if they have symptoms of disease, would classify themselves as unhealthy only if they could not fulfill their roles in life, such as mother or worker. The clinical model of health focuses on the elimination of disease or symptoms. In the adaptive model, health involves adaptation to the environment. The eudaimonistic model of health holds that health is the actualization or realization of human potential.
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The nurse works to identify epidemiologic transitions in the community. Which is an example of a demographic transition? A) High fertility and high mortality, resulting in slow population growth B) Progressive declines in mortality, as epidemics become less frequent C) High and fluctuating mortality, due to poor health, epidemics, and famine D) Further declines in mortality, increasing life expectancy, and predominance of noncommunicable diseases
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A) High fertility and high mortality, resulting in slow population growth Ans: A Feedback: Demographic transitions may progress from low to high levels and include the following: high fertility and high mortality, resulting in slow population growth; improvement in hygiene and nutrition, leading to a decreased burden of infectious disease; declines in mortality and, later, declines in fertility. Epidemiologic transitions include the following: high and fluctuating mortality, due to poor health, epidemics, and famine; progressive declines in mortality, as epidemics become less frequent; and further declines in mortality, increasing life expectancy, and predominance of noncommunicable diseases.
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20. The nurse is migrating from a developing nation to a developed nation. This migration ultimately benefits the nurse's home country if the nurse: (Select all that apply.) A) Returns to the home country with advanced practice skills B) Returns to the home country and teach others what was learned C) Shares with the new coworkers nursing practices unique to the nurse's home country D) Earn more money in the position in the new country E) Is safer from exposure to HIV in the new country
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A) Returns to the home country with advanced practice skills B) Returns to the home country and teach others what was learned Ans: A, B Feedback: Workers who migrate gain new skills in the receiving countries and can return to their native countries revitalized with education and new outlooks on solving the problems—in other words, "brain gain." Those who leave may also come back with the skills to educate other workers. For example, nurses may return with advanced practice nursing skills and become educators in their respective countries. Sharing nursing practices with coworkers in the new job might benefit them and their clients but would not benefit the home country. Earning more money and being safer from exposure to HIV would benefit the nurse, but not the nurse's home country.
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21. The community health nurse in a low-income country is working to decrease the incidence of diarrheal illnesses. Which intervention would most likely best address this problem? A) Providing fuel alternatives to burning wood and dung B) Providing sanitized drinking water C) Education regarding contraception use D) Distribution of and education on the daily use of insecticide-treated bed nets
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B) Providing sanitized drinking water Ans: B Feedback: Unclean water remains a major problem in reducing diarrheal illness and waterborne and water-related illnesses and their health consequences. Educating families on the daily use of insecticide-treated bed nets would address malaria, as malaria is spread predominantly by mosquitoes, but there is no indication that malaria is the culprit here. Diarrheal illnesses are not directly related to burning wood or dung or to sexual intercourse.
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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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A) Major cardiovascular-renal disease 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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Who first described pulmonary tuberculosis in detail? A) Hippocrates of Cos B) Aretaeus the Cappadocian C) Claudius Galen D) Susruta
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B) Aretaeus the Cappadocian 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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Who is considered the first epidemiologist? A) Hippocrates of Cos B) Aretaeus the Cappadocian C) Claudius Galen D) Susruta
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A) Hippocrates of Cos 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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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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D) A tentative hypothesis is formulated 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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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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A) William Farr 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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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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D) Morbidity and mortality from noninfectious diseases have increased. 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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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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C) Study of the distribution and determinants of states of health and illness in human populations 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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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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B) Primary measurement used to describe either the occurrence or the existence of a specific state of health or illness 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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B) John Graunt 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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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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D) John Snow 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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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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A) Epidemiologic triad 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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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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C) Web of causation 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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Origin: Chapter 6- Epidemiology- The Science of Prevention, 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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D) Refer clients who have experienced neurological deficits because of the disease to a neurologist to begin rehabilitation. 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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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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B) Actions are initiated to carry out the plan 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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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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D) Characteristic or event that has been shown to increase the probability that a specific disease or illness will develop 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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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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C) Pathological onset, presymptomatic, manifestation of clinical disease 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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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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A) The names of all people who have been infected by the virus B) The geographical area within which the outbreak has occurred D) The time of onset and duration of the outbreak 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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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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B) Wheel of causation 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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A) Measure epidemiologic statistics before and after administering the flu shots. B) Plan and evaluate influenza vaccinations regularly. D) As new data regarding influenza vaccinations become available, modify the intervention accordingly. 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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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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C) Florence Nightingale 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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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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D) Establish the existence of the outbreak 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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Which is the primary method used to measure the existence of states of health or illness in a population during a given time period? A) Rate B) Ratio C) Relative risk ratio D) Sensitivity
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A) Rate Ans: A Feedback: Rate is the primary measurement used to describe the occurrence (quantity) of a state of health in a specific group of people in a given time period. Ratio is a fraction that represents the relationship between two numbers. Relative risk ratio is the ratio of the incidence rate in the exposed group to the incidence rate in the nonexposed group. Sensitivity is the ability of a test to correctly identify people who have a health problem or the probability of testing positive if the health problem is truly present.
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Which correctly defines an adjusted rate? A) Statistical procedure that removes the effects of differences in the composition of a population, such as age, when comparing one with another B) Measure of the probability that people without a certain condition will develop that condition over a period of time C) Measure of the number of people in a given population who have an existing condition at a given point in time D) Detailed rates that are calculated using the number of people in the smaller subgroups of the population in the denominator
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A) Statistical procedure that removes the effects of differences in the composition of a population, such as age, when comparing one with another Ans: A Feedback: Adjusted rate is the statistical procedure that removes the effects of differences in the composition of a population, such as age, when comparing one with another. Incidence rate is the measure of the probability that people without a certain condition will develop that condition over a period of time. Prevalence rate is the measure of the number of people in a given population who have an existing condition at a given point in time. Specific rates are detailed rates that are calculated using the number of people in the smaller subgroups of the population in the denominator. Often people are divided into subgroups by age and sex, although any characteristic can be used.
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Which rate measures the number of people in a given population who have influenza at a given point in time? A) Adjusted B) Incidence C) Prevalence D) Specific
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C) Prevalence Ans: C Feedback: Prevalence rate is the measure of the number of people in a given population who have an existing condition at a given point in time. Adjusted rate is the statistical procedure that removes the effects of differences in the composition of a population, such as age, when comparing one with another. Incidence rate is the measure of the probability that people without a certain condition will develop that condition over a period of time. Specific rates are detailed rates that are calculated using the number of people in the smaller subgroups of the population in the denominator. Often people are divided into subgroups by age and sex, although any characteristic can be used.
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The nurse is measuring the occurrence of chronic obstructive pulmonary disease being investigated in the entire population. Which rate does this represent? A) Adjusted B) Attack C) Crude D) Incidence
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Ans: C Feedback: Crude rate is the measurement of the occurrence of the health problem or condition being investigated in the entire population. Adjusted rate is the statistical procedure that removes the effects of differences in the composition of a population, such as age, when comparing one with another. Attack rate is the incidence or occurrence rate. Incidence rate is the measure of the probability that people without a certain condition will develop that condition over a period of time.
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The nurse wishes to compare the number of persons aged 40 to 49 years who die each year with the midyear population of persons in this age range, per 100,000 population. Which type of rate is the nurse attempting to calculate? A) Adjusted B) Incidence C) Prevalence D) Specific
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D) Specific Ans: D Feedback: Specific rates are detailed rates that are calculated using the number of people in the smaller subgroups of the population in the denominator. Often people are divided into subgroups by age and sex, although any characteristic can be used. Adjusted rate is the statistical procedure that removes the effects of differences in the composition of a population, such as age, when comparing one with another. Incidence rate is the measure of the probability that people without a certain condition will develop that condition over a period of time. Prevalence rate is the measure of the number of people in a given population who have an existing condition at a given point in time.
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The nurse wishes to determine how many people in the city die from heart attacks each year per 100,000 population. Which type of rate is the nurse attempting to calculate? A) Age-specific mortality rate B) Cause-specific mortality rate C) Case fatality rate D) Crude mortality rate
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B) Cause-specific mortality rate Ans: B Feedback: Cause-specific mortality rates indicate the probability of death from a specific cause; the number of deaths from a specific disease is divided by the number of people in the population at midyear and multiplied by 100,000. Age-specific mortality rates indicate the probability of death among those of a specific age group; the number of deaths in the age group is divided by the number of people in that age group in the population at midyear and multiplied by 100,000. In calculating the case fatality rate, the number of people with a specific disease such as lung cancer becomes the subgroup being studied out of the entire population in a designated geographic area. Crude mortality rate is simply the number of deaths occurring in 1 year divided by the midyear population and multiplied by 100,000.
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Which correctly defines sensitivity? A) The ratio of the incidence rate in the exposed group to the incidence rate in the nonexposed group B) Ability of a test to correctly identify people who have a health problem or the probability of testing positive if the health problem is truly present C) Variations measured in hours, days, weeks, or months and commonly used to quantify outbreaks of infectious disease D) Ability of a test to correctly identify people who do not have a health problem or the probability of testing negative if the health problem is truly absent
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B) Ability of a test to correctly identify people who have a health problem or the probability of testing positive if the health problem is truly present Ans: B Feedback: Sensitivity is the ability of a test to correctly identify people who have a health problem or the probability of testing positive if the health problem is truly present. Relative risk ratio is the ratio of the incidence rate in the exposed group to the incidence rate in the nonexposed group. Short-term changes are variations measured in hours, days, weeks, or months and are commonly used to quantify outbreaks of infectious disease. Specificity is the ability of a test to correctly identify people who do not have a health problem or the probability of testing negative if the health problem is truly absent.
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The nurse wishes to measure the number of cases of staph infections that occur in a hospital over the course of 1 year per total client-days during that year. Which measure should the nurse use? A) Incidence density B) Prevalence rate C) Relative risk ratio D) Specific rate
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A) Incidence density Ans: A Feedback: Incidence density is the use of a person-time denominator in the calculation of rates. A person-day reflects one person at risk for 1 day, and a person-year represents one person at risk for 1 year. Prevalence rate is the measure of the number of people in a given population who have an existing condition at a given point in time. Relative risk ratio is the ratio of the incidence rate in the exposed group to the incidence rate in the nonexposed group. Specific rates are detailed rates that are calculated using the number of people in the smaller subgroups of the population in the denominator.
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Incidence rates for groups exposed to a secondhand smoke are compared with the incidence rates for people who are not exposed to secondhand smoke. This will measure the: A) Incidence density B) Prevalence rate C) Relative risk ratio D) Specific rate
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C) Relative risk ratio Ans: C Feedback: Relative risk ratio is the ratio of the incidence rate in the exposed group to the incidence rate in the nonexposed group. Incidence density is the use of a person-time denominator in the calculation of rates. A person-day reflects one person at risk for 1 day, and a person-year represents one person at risk for 1 year. Prevalence rate is the measure of the number of people in a given population who have an existing condition at a given point in time. Specific rates are detailed rates that are calculated using the number of people in the smaller subgroups of the population in the denominator.
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The nurse wishes to calculate the probability of persons in your county developing chronic obstructive pulmonary disease over the course of a year. Which measure should the nurse use? A) Incidence density B) Incidence rate C) Relative risk ratio D) Specific rate
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B) Incidence rate Ans: B Feedback: Incidence rate is the measure of the probability that people without a certain condition will develop that condition over a period of time. Incidence density is the use of a person-time denominator in the calculation of rates. A person-day reflects one person at risk for 1 day, and a person-year represents one person at risk for 1 year. Relative risk ratio is the ratio of the incidence rate in the exposed group to the incidence rate in the nonexposed group. Specific rates are detailed rates that are calculated using the number of people in the smaller subgroups of the population in the denominator.
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Over the course of a year, there were 42 cases of institution-associated pneumonia at a hospital. During that time, 3,102 clients were at risk for acquiring this infection, with 20,411 client-days. Which is the crude incidence rate of institution-associated pneumonia at this hospital? A) 0.21% B) 1.35% C) 1.52% D) 15.20%
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B) 1.35% Ans: B Feedback: Crude incidence rate is calculated by dividing the number of occurrences or cases of a health problem by the number of people in the population who are at risk for the health problem. In this case, the following equation would result: 42/3,102 = 0.0135 = 1.35%.
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Over the course of a year, there were 42 cases of institution-associated pneumonia at a hospital. During that time, 3,102 clients were at risk for acquiring this infection, covering a total of 20,411 client-days. Which is the client density in terms of number of cases per 1,000 client-days at this hospital during this time? A) 2.1 B) 13.5 C) 15.2 D) 152
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A) 2.1 Ans: A Feedback: Incidence density is calculated by dividing the number of new cases occurring during the study period by the person-time units accumulated by subjects during the study period and multiplying the result by the base multiple of 10. In this case, the following equation would result: 42/20,411 = 0.0021 × 1,000 = 2.1 cases per 1,000 client-days.
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In reviewing a study that considered the sensitivity of a particular screening test for HIV, the nurse found 21 true positives, 853 true negatives, 3 false positives, and 5 false negatives. What is the sensitivity of this test? A) 80.8% B) 87.5% C) 93.7% D) 99.6%
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A) 80.8% Ans: A Feedback: Sensitivity is calculated by dividing the number of true positives by the sum of the number of true positives and false negatives. In this case, the sensitivity would be calculated as follows: 21/21 + 5 = 21/26 = 0.808 = 80.8%.
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City A has a population of people who are exposed to HIV, whereas City B has a population of people who are considered nonexposed to HIV. There were 3,267 new HIV cases in a given year for City A, with a population (exposed) of 10,000,000. There were only 5 new HIV cases in the same year for City B, with a population (nonexposed) of 150,000. Which is the attributable risk of HIV occurring in City A in terms of cases per 100,000 population? A) 3.33 B) 13.55 C) 29.34 D) 32.67
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C) 29.34 Ans: C Feedback: Attributable risk is calculated by subtracting the incidence rate in a nonexposed population from the incidence rate in an exposed population. In this case, we first need to calculate the individual incidence rates for City A and City B and then subtract to find the attributable risk for City A. The incidence rate for City A is calculated as follows: 3,267/10,000,000 = 0.0003267 × 100,000 = 32.67 cases per 100,000 population. The incidence rate for City B is calculated as follows: 5/150,000 = 0.0000333 × 100,000 = 3.33 cases per 100,000 population. The attributable risk for HIV occurring in City A, then, is calculated as follows: 32.67 - 3.33 = 29.34 cases per 100,000 population.
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The nurse graphs the distribution of influenza cases by the time of onset of influenza. Which would be the result of this work? A) Epidemic curve B) Epidemiologic descriptive study C) Incidence density D) Incidence rate
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A) Epidemic curve Ans: A Feedback: An epidemic curve is a graph that plots the distribution of cases by the time of onset of the disease. Epidemiologic descriptive studies are research studies designed to acquire more information about the occurrence and distribution of states of health, such as characteristics of person, place, and time. Incidence density is the use of a person-time denominator in the calculation of rates. A person-day reflects one person at risk for 1 day, and a person-year represents one person at risk for 1 year. Incidence rate is the measure of the probability that people without a certain condition will develop that condition over a period of time.
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The nurse is conducting research on the relative risk of acquiring lung cancer as a result of being exposed to secondhand smoke. The nurse is studying two different groups. Group A includes 400 adults who do not smoke but are exposed to secondhand smoke in their home on a daily basis. Group B includes 400 adults who do not smoke and are not exposed to secondhand smoke in their home. Over the course of 10 years, 20 subjects in Group A are diagnosed with lung cancer, whereas only 2 subjects in Group B are diagnosed with lung cancer. Which is the relative risk ratio that would result from this study? A) 0.5 B) 1 C) 5 D) 10
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D) 10 Ans: D Feedback: Relative risk ratio compares the incidence rate of a group exposed to a certain risk factor with the incidence rate of a group not exposed to the risk factor. It is calculated by dividing the incidence rate in the exposed group by the incidence rate in the nonexposed group. In this case, we need to first calculate the separate incidence rates for Group A and Group B and then divide to find the relative risk ratio. The incidence rate for Group A is calculated as follows: 20/400 = 0.05 × 1,000 = 50 cases per 1,000 population. The incidence rate for Group B is calculated as follows: 2/400 = 0.005 × 1,000 = 5 cases per 1,000 population. The relative risk ratio, then, is calculated as follows: 50/5 = 10.
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The nurse is preparing a research study on the number of heart attacks in the community and the number of individuals who are actively involved in exercise programs following a heart attack. Using knowledge of research study design, which gold standard for a research design should be considered? A) Randomized, control group B) Quasi-experimental C) Experimental D) Descriptive epidemiologic
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A) Randomized, control group Ans: A Feedback: The "gold standard" for experimental studies is the prospective, double-blind, placebo-control group design, also referred to as clinical trials or therapeutic trials. In double-blind experimental studies, neither the researchers nor the subjects are aware to which group they are randomly assigned. Quasi-experimental and experimental designs are used to examine causality. Many studies, although experimental in design, are not able to either randomize selection of subjects or exert the same degree of control of the study variables that would be found in true experimental studies. Descriptive epidemiologic studies, which are frequently used in public health, are designed to acquire more information about characteristics of health (or disease) as they pertain to person, place, and time. Findings from descriptive epidemiologic studies lead to hypotheses for future research.
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The nurse is preparing to do a research study on the effects of tight insulin control for diabetes. Using the knowledge that epidemiologic research can be descriptive or analytical, which would be the strongest study design to consider? A) Retrospective B) Quasi-experimental C) Experimental D) Randomized, control group
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D) Randomized, control group Ans: D Feedback: Analytical research study designs are on a continuum, ranging from strongest to weakest designs. The research continuum indicates that experimental study designs are the strongest because they control for all factors except that which is under study, with the "gold standard" for research design being the randomized, control group design. Two analytical designs, the prospective correlational design and the retrospective correlational design, are "weaker" designs on the continuum. Quasi-experimental study designs are stronger than retrospective studies but weaker than experimental because assignment of subjects into groups is not randomized or the researcher is unable to manipulate the variable under study.
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The nurse reads a research article that reviews causality. Using knowledge of research designs, which types of design examine causality? (Select all that apply.) A) Retrospective B) Quasi-experimental C) Experimental D) Randomized, control group E) Case-controlled .
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B) Quasi-experimental C) Experimental D) Randomized, control group Ans: B, C, D Feedback: Quasi-experimental and experimental designs are used to examine causality. The "gold standard" for research design is the randomized, control group design, which is a type of experimental design. Retrospective, or case-controlled, studies do not examine causality.
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The nurse conducts a study that will follow a group of subjects for two decades. It involves one group of subjects who have a risk factor for developing diabetes and another group who do not have a risk factor. The goal is to establish a cause-and-effect relationship between the existence of the risk factor and the occurrence of diabetes. Which study design would be most appropriate? A) Cohort B) Case-control C) Preventive D) Therapeutic
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A) Cohort Ans: A Feedback: Cohort studies, sometimes referred to as longitudinal studies, are prospective studies that monitor subjects over time to find associations between risk factors and health outcomes. In their simplest form, a sample (cohort) of subjects who are exposed to the risk factor(s) is matched with a sample of subjects not exposed to the risk factor. Cohort studies attempt to find cause-and-effect relationships. Case-control studies, also known as retrospective studies, work backward from the effect to the suspected cause. Subjects are selected on the basis of the presence or absence of the disease or outcome in question: one group of people (case-subjects) with the health problem and another group without the health problem (controls). The two groups are then compared to determine the presence of specific exposures or risk factors. A preventive study is focused on preventing the occurrence of disease in subjects. Therapeutic trials are based on secondary prevention, which focuses on limiting the spread of disease, and where the treatment (independent variable) is manipulated by the researcher.
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The nurse is participating in study that considers the effect that use of netting around beds has on the incidence of malaria in a community of subjects in Africa. Which type of study would be best for this purpose? A) Cohort B) Case-control C) Preventive D) Therapeutic
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C) Preventive Ans: C Feedback: A preventive study is focused on the effect of measures to prevent the occurrence of disease in subjects. Cohort studies, sometimes referred to as longitudinal studies, are prospective studies that monitor subjects over time to find associations between risk factors and health outcomes. In their simplest form, a sample (cohort) of subjects who are exposed to the risk factor(s) is matched with a sample of subjects not exposed to the risk factor. Cohort studies attempt to find cause-and-effect relationships. Case-control studies, also known as retrospective studies, work backward from the effect to the suspected cause. Subjects are selected on the basis of the presence or absence of the disease or outcome in question: one group of people (case-subjects) with the health problem and another group without the health problem (controls). The two groups are then compared to determine the presence of specific exposures or risk factors. Therapeutic trials are based on secondary prevention, which focuses on limiting the spread of disease, and where the treatment (independent variable) is manipulated by the researcher.
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6. The nurse is conducting a study on heart clients who are actively involved in exercise programs following a heart attack. The nurse should consider which as a threat to internal validity? A) Some subjects run faster on the treadmill when a researcher walks through the room. B) Including an exciting new cross-fit training program as one of the exercise options that can accommodate a few of the study subjects C) Your fervent belief from personal experience that intense cardiovascular exercise can speed recovery and prevent further heart attacks D) Using a variety of stationary bicycles for stress testing
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D) Using a variety of stationary bicycles for stress testing Ans: D Feedback: A threat to internal validity is instrumentation, which refers to changes in the measurement instrument used in the study and which results in inconsistent data collection. Threats to external validity include reactivity, novelty, and experimenter/participant effect.
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The nurse is conducting a study that will consider how heart clients respond to various interventions following a heart attack. The nurse is concerned about the threat that testing could pose to the internal validity of the study. How might testing affect the study? A) The long commute that a subject must take to a testing center as part of the study might change the subject's response to an intervention. B) One subject develops an unrelated anemia, which causes fatigue, which in turn affects the outcome of the study. C) Multiple measurements of participants' cortisol levels could cause stress in the participants and thus influence their cortisol levels, thereby altering the outcome of the study. D) Mistakes are made when a number of subjects who should have been assigned to one intervention group are assigned to another, which may affect the outcome of the study.
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C) Multiple measurements of participants' cortisol levels could cause stress in the participants and thus influence their cortisol levels, thereby altering the outcome of the study. Ans: C Feedback: Testing is the effect of multiple measurements of participants' responses that could influence the participants' responses, thereby altering the outcome of the study. History is events that are occurring during the study, which could influence participants' responses to the intervention. Maturation is unplanned and unrecognized changes in the participants that could affect the findings of the study, such as fatigue, hunger, or increased knowledge. Selection is the process by which participants are selected and grouped for a study. This threat is more likely to occur when randomization is not possible.
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The nurse reviews published research studies on the number of heart clients who are actively involved in exercise programs following a heart attack in preparation of conducting similar research. Using knowledge of research validity, which threat to external validity must be considered? A) Loss of a subject due to a second heart attack B) Selection of a subject who does not meet the eligibility criteria for the study C) A subject pedaling faster on the stationary bicycle whenever an examiner walks in the room D) An unexpected increase in a subject's appetite that could affect the studyr
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C) A subject pedaling faster on the stationary bicycle whenever an examiner walks in the room Ans: C Feedback: A threat to external validity is reactivity, also known as the "Hawthorne effect," which occurs when participants behave in a certain way because they know they are being studied, affecting the generalizability of the findings. Threats to internal validity include mortality (the loss of subjects from the study), selection (the process by which participants are selected and grouped for a study), and maturation (the unplanned and unrecognized changes in the participants that could affect the findings of the study, such as fatigue, hunger, or increased knowledge).
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The nurse is conducting a study on how regular physical activity affects the risk for developing lung cancer among smokers. One group leads a sedentary lifestyle whereas the other has agreed to undergo regular supervised exercise in the gym of a local hospital. During the study, the sole treadmill in the gym broke down and was unable to be used for the last half of the study. Several study participants who preferred the treadmill to other machines did not exercise as long or as intensely as they might otherwise have. Which threat to the external validity of the study does this represent? A) Interaction of history and intervention B) Interaction of selection and intervention C) Experimenter/participant effect D) Novelty
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A) Interaction of history and intervention Ans: A Feedback: Interaction of history and intervention occurs when the circumstances of the study influence the results of the study, decreasing the generalizability of the findings. Such is the case with the broken treadmill that potentially decreased the participant's overall exercise volume. Interaction of selection and intervention occurs when subjects willing to participate in the study are not representative of the target population, thus limiting the generalizability of the results. Experimenter/participant effect occurs when the researcher has preconceived expectations of the intervention, resulting in bias and affecting the generalizability of the findings. Novelty occurs when a new intervention affects the outcome of the study because of either enthusiasm or skepticism by the researchers or the participants.
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The nurse wishes to conduct a study on the effectiveness of animal-assisted therapy in alleviating symptoms of depression. One group of subjects would attend regular counseling sessions in the company of a dog, whereas the other group would attend regular counseling sessions without a dog present. In this study, the dogs would represent: A) Control group B) Treatment group C) Intervention D) Placebo
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C) Intervention Ans: C Feedback: The hallmark of the experimental study is random assignment of subjects to treatment (intervention) and control groups, which controls for potential unknown confounding variables. In this case, the dogs are the intervention or treatment, the group of subjects who are exposed to them during counseling sessions are the treatment group, and the group of subjects who are not exposed to them are the control group. Placebo refers to the control group.
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Which best describes a prospective study? A) Descriptive study in which participants are enrolled before the health outcome of interest has occurred B) Analytic study in which participants are enrolled before the health outcome of interest has occurred C) Descriptive study in which participants are enrolled after the health outcome of interest has occurred D) Analytic study in which participants are enrolled after the health outcome of interest has occurred
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B) Analytic study in which participants are enrolled before the health outcome of interest has occurred Ans: B Feedback: A prospective study is an analytic study in which participants are enrolled before the health outcome of interest has occurred. A retrospective study is an analytic study in which participants are enrolled after the health outcome of interest has occurred.
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The nurse reviews a published analytical research study that compares one group of clients who developed diabetes mellitus before the start of the study with a group of clients without diabetes mellitus. Which type of study design was used in this study? A) Case control B) Case C) Clinical trial D) Cohort
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A) Case control Ans: A Feedback: A case-control study is an observational analytic study that enrolls one group of persons with a certain health problem (case-clients) and a group of persons without the health problem (control subjects). It compares differences in exposures, behaviors, and other characteristics to identify and quantify associations, test hypotheses, and identify causes. A case study is a research method that involves an in-depth analysis of an individual, group, or institution. A clinical trial is an experimental study in which the investigator specifies the type of exposure for each study participant and then follows each person's health status to determine the effects of the exposure. A cohort study is an observational analytic study in which enrollment is based on the status of exposure to a certain factor or membership in a certain group.
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The nurse researches the relationship between frequent ingestion of fast foods and obesity. The nurse finds that in a population that eats at least five fast food meals per week on average, the incidence rate of people who are obese is 735/1,000 population. In the population that eats only one fast food meal per week on average, the incidence rate of people who are obese is 245/1,000 population. Based on these findings, what is the relative risk of developing obesity in those who eat at least five fast food meals per week? A) 0.3 B) 0.7 C) 1 D) 3
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D) 3 Ans: D Feedback: Relative risk (RR) is defined as the ratio of disease incidence (or death) in an exposed population to that in an unexposed population. The assumption is that the underlying risk without the exposure is the same in both groups. Relative risk is a ratio ranging from 0 to infinity that indicates the strength of the association between the risk factor and the outcome. It is calculated by dividing the risk in the group exposed to a risk factor by the risk in the unexposed group. In this case, we perform the following calculation: 735/245 = 3. An RR significantly greater than 1 (statistically) indicates that the exposure is associated with increased risk of disease. An RR significantly less than 1 (statistically) indicates that the exposure is associated with decreased risk of disease; that is, the exposure is protective. An RR not significantly different from 1 (statistically) indicates that there is no association between the exposure and the risk of disease.
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Advantages of a case-control study include: (Select all that apply). A) Allows for the examination of multiple exposures for a single outcome B) Allows for the direct measure of the incidence of a disease C) Is generally quicker and less expensive to conduct than cohort studies D) Appropriate for studying rare exposures E) Requires fewer case-subjects
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A) Allows for the examination of multiple exposures for a single outcome C) Is generally quicker and less expensive to conduct than cohort studies E) Requires fewer case-subjects Ans: A, C, E Feedback: Case-control studies have several advantages: they allow for the examination of multiple exposures for a single outcome, are suitable for studying rare diseases and those with long latency periods, require fewer case-subjects, and generally are quicker and less expensive to conduct than cohort studies, making them well suited for an outbreak investigation. They have several disadvantages: they are not appropriate for studying rare exposures, they are subject to bias because of the method used to select controls, and they do not allow the direct measure of the incidence of disease.
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Clients in the nurse's caseload have been requested to participate in a therapeutic trial about H1N1 influenza. Using knowledge of trials, the nurse tells the clients that the trial: A) Is based on primary prevention of H1N1 influenza B) Is dependent variable manipulated by the researcher C) Focuses on limiting the spread of H1N1 influenza D) Focuses on reducing the incidence of H1N1 influenza
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C) Focuses on limiting the spread of H1N1 influenza Ans: C Feedback: Therapeutic trials are based on secondary prevention, which focuses on limiting the spread of disease and where the treatment (independent variable) is manipulated by the researcher. Preventive trials focus on primary prevention to reduce the incidence of disease.
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Which ensures that a study's results are not due to chance alone? A) Rejecting the null hypothesis B) Setting the p value to .05 C) Calculating the risk ratio D) Using a preventive study design
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B) Setting the p value to .05 Ans: B Feedback: The researcher should set the expected statistical p value, generally at .05, to ensure that the study results are not due to chance alone. Rejecting the null hypothesis when it is true is known as a type I error and does not ensure that a study's results are not due to chance alone. Relative risk is a ratio ranging from 0 to infinity that indicates the strength of the association between the risk factor and the outcome. However, calculating it does not ensure that a study's results are not due to chance alone. Using a preventive study design does not ensure that a study's results are not due to chance alone.
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The best description of a type II error is that it occurs when: A) The null hypothesis is rejected when it is true. B) One rejects the alternative hypothesis when it is false. C) The null hypothesis is accepted when it is false. D) One accepts the alternative hypothesis when it is true.
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C) The null hypothesis is accepted when it is false. Ans: C Feedback: A type II error occurs when one accepts the null hypothesis when it is false. A type I error occurs when the null hypothesis is rejected when it is true.
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The nurse studies the association of lead poisoning with residence in a home that was built before 1970. Which needs to be established to show an association between these two variables? A) A statistical relationship between lead poisoning and residence in a home built before 1970 B) That the presence or absence of residence in a home built before 1970 determines the presence or absence, respectively, of lead poisoning C) A relative risk of 1 D) A p value > 0.1
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A) A statistical relationship between lead poisoning and residence in a home built before 1970 Ans: A Feedback: An association is a statistical relationship between two or more events, characteristics, or other variables. Causality is the relationship between two variables in which the presence or absence of one variable (the "cause") determines the presence or absence of the other (the "effect"). A relative risk not significantly different from 1 (statistically) indicates that there is no association between the exposure and the risk of disease. A p value > 0.1 indicates a lack of statistical relationship.
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The nurse wishes to conduct research on the number of cancer clients who are actively involved in exercise programs following chemotherapy. To prepare, the nurse reviews similar, published research studies. The nurse knows that maturation can be a threat to internal validity of the research study. Which is an example of maturation? A) A heat wave occurred during the study and clients who normally exercised outside were unable to do so. B) A client developed fatigue and was unable to complete the exercise program. C) Repeated stress tests on stationary bicycles demotivated clients from participating. D) Inclusion of a former Olympic athlete in the study skewed the results.
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B) A client developed fatigue and was unable to complete the exercise program. Ans: B Feedback: Maturation is unplanned and unrecognized changes in the participants that could affect the findings of the study, such as fatigue, hunger, or increased knowledge. History is events that are occurring during the study, which could influence participants' responses to the intervention. Testing is effect of multiple measurements of participants' responses that could influence the participants' responses, thereby altering the outcome of the study. Selection is the process by which participants are selected and grouped for a study. This threat is more likely to occur when randomization is not possible.
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The nurse reviews published research studies on clients with developmental disabilities who receive music therapy once a week. Using knowledge of research studies, what type of research study would entail an in-depth analysis of one group of developmentally disabled individuals and the effects of music therapy? A) Case control B) Case C) Clinical trial D) Cohort
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B) Case Ans: B Feedback: A case study is a research method that involves an in-depth analysis of an individual, group, or institution. A case-control study is an observational analytic study that enrolls one group of persons with a certain health problem (case-clients) and a group of persons without the health problem (control subjects). It compares differences in exposures, behaviors, and other characteristics to identify and quantify associations, test hypotheses, and identify causes. A clinical trial is an experimental study in which the investigator specifies the type of exposure for each study participant and then follows each person's health status to determine the effects of the exposure. A cohort study is an observational analytic study in which enrollment is based on the status of exposure to a certain factor or membership in a certain group.
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21. The nurse is conducting a cross-sectional study of people who are HIV positive and their exposure to certain risk factors. Given the nature of this type of study, which would be true? (Select all that apply.) A) Respondents are a sample that represents the entire population. B) The results of the study will allow determination of cause and effect. C) Data represent a point in time. D) Data are gathered via a questionnaire or interview. E) Subjects are randomly assigned to treatment and control groups.
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A) Respondents are a sample that represents the entire population. C) Data represent a point in time. D) Data are gathered via a questionnaire or interview Ans: A, C, D Feedback: Cross-sectional studies (prevalence studies) are an example of public health survey research. Survey research focuses on the collection of information regarding the status quo of some situation(s) by questionnaire or by interviews with a sample of respondents. The main principle of survey research is that the sample of respondents must represent the population from which it was drawn. In this type of study, the population to be studied is defined, and data are collected from members of the group about their disease and exposure status. The data represent a point in time; therefore, they provide a "snapshot" of the population. Cross-sectional studies are good for examining the relationship between a variable and a disease/condition but not for determining cause and effect, which requires the collection of data over time. Subjects are randomly assigned to treatment and control groups in randomized, control group intervention studies, not in cross-sectional studies.
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Which is the most accurate definition of an exposure pathway? A) The total amount of a contaminant that comes in direct contact with the body B) Factor that determines a person's level of exposure to a contaminant C) Method by which people are exposed to an environmental contaminant D) Process to determine whether exposure to an environmental contaminant has occurred
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C) Method by which people are exposed to an environmental contaminant Ans: C Feedback: An exposure pathway is the method by which people are exposed to an environmental contaminant that originates from a specific source. Exposure is a measure of the total amount of a contaminant that comes in direct contact with the body. An exposure estimate is a method of determining a person's level of exposure to a contaminant on the basis of associated factors. An exposure history is a process to help determine whether an individual has been exposed to environmental contaminants.
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The nurse travels to Nigeria with a humanitarian aid organization to assess and treat members of a remote community. The children all have high levels of lead in their blood, as a result of exposure to lead dust created by gold mining. Many children are dying. The nurse has never witnessed such a phenomenon in the United States. Which are the most likely reasons for this discrepancy? (Select all that apply.) A) Larger mining operations than in the United States B) Lack of environmental regulations or of their enforcement C) Lack of knowledge concerning environmental dangers D) Weaker immune systems than in the United States E) Need of the miners to earn a living and fewer work options
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B) Lack of environmental regulations or of their enforcement C) Lack of knowledge concerning environmental dangers E) Need of the miners to earn a living and fewer work options Ans: B, C, E Feedback: This situation is caused by a combination of limited environmental protections, lack of knowledge concerning environmental dangers by local community members, and the need to earn an income. The size of the mining operations is not relevant. The strength of the children's immune system is irrelevant, as the immune system is effective against invading microorganisms, not against lead.
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3. The nurse visits the home of client in a low-income community and notices that paint is flaking off the walls and forming a dust in the corners of some rooms. The nurse asks the client when the house was built, and she responds that it was built in 1959. Which contaminant should the nurse expect to find in this home? A) Lead B) Radon C) Asbestos D) Pesticide
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A) Lead Ans: A Feedback: Contaminants in the environment, such as asbestos, lead, or radon, influence human health. For example, lead was used in paint until the 1970s and is often found in houses built earlier. As the old paint breaks down, lead can be found in dust and old paint chips in homes. In communities with older, deteriorating housing, children can be exposed to lead. In many cases, such housing is found in poorer communities. There are no indications of the other contaminants being present.
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Several important pieces of legislation have helped highlight the importance of environmental health and environmental protection. Which best describes Superfund? A) National program to control the damaging effects of air pollution B) Program that protects and enhances the quality of the nation's air by regulating stationary and mobile sources of air emissions C) Environmental program established to address abandoned hazardous waste sites D) Comprehensive framework of standards, technical tools, and financial assistance to address the many causes of pollution and poor water quality
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C) Environmental program established to address abandoned hazardous waste sites Ans: C Feedback: Superfund is the name given to the environmental program established to address abandoned hazardous waste sites. The Clean Water Act focuses on improving the quality of the nation's waters. It provides a comprehensive framework of standards, technical tools, and financial assistance to address the many causes of pollution and poor water quality, including municipal and industrial wastewater discharges, polluted runoff from urban and rural areas, and habitat destruction. The Clean Air Act is a national program to control the damaging effects of air pollution. It protects and enhances the quality of the nation's air by regulating stationary and mobile sources of air emissions.
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Which is the most accurate definition of a risk assessment? A) Assessment of the adverse effects of chemical, physical, or biological agents on people, animals, and the environment B) Process to help determine whether an individual has been exposed to environmental contaminants C) Assessment of factors that determine a person's level of exposure to an environmental contaminant D) Determination of the likelihood of adverse effects in a group exposed to an environmental contaminant
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D) Determination of the likelihood of adverse effects in a group exposed to an environmental contaminant Ans: D Feedback: Risk assessment is the process to determine the likelihood or probability that adverse effects such as illness or disease will occur in a group of people because of an exposure to an environmental contaminant. Toxicology is the study of the adverse effects of chemical, physical, or biological agents on people, animals, and the environment. Exposure history is the process to help determine whether an individual has been exposed to environmental contaminants. Exposure estimate is assessment of factors that determine a person's level of exposure to a contaminant.
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There are different methods for conducting risk assessment for environmental contaminants. Which formula determines the amount of risk? A) Hazard = exposure × risk B) Exposure = risk × hazard C) Risk = contaminant presence × exposure D) Risk = hazard × exposure
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D) Risk = hazard × exposure Ans: D Feedback: A key concept for assessing risk is that the amount of risk equals the hazard times the exposure (risk = hazard × exposure). The presence of a hazard alone does not determine the amount of risk the hazard poses.
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Which exemplify environmental media and transport mechanisms within an exposure pathway? (Select all that apply.) A) Mercury B) Groundwater C) Pond D) Air E) Subsurface soil
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B) Groundwater C) Pond D) Air E) Subsurface soil Ans: B, C, D, E Feedback: Environmental media include groundwater, surface water (lakes, ponds, and rivers), air, surface soil, subsurface soil, sediment, and biota (plants and animals). The environmental medium that the contaminant is in helps determine who is exposed and how they are exposed. Mercury is an example of a contaminant, or source of contamination.
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Which is an example of a radiological contaminant? A) Lead B) Mercury C) Ricin D) Radon
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D) Radon Ans: D Feedback: Generally, contaminants can be thought of in three categories: chemical (lead, mercury, volatile organic compounds), biological (mold, anthrax, ricin), and radiological (radium, radon).
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The nurse visits a community along a creek where residents have begun to report upper respiratory illnesses and asthma. After investigating, the nurse learns that several miles upstream is a hazardous material disposal site. In addition, chemicals have leached through the soil into the creek water and have been carried downstream to this community. Although children are not allowed into the creek, they do often play along the bank. Which represents the route of exposure in this situation? A) Creek water B) Chemicals C) Bank of the creek D) Inhalation
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D) Inhalation Ans: D Feedback: The route of exposure is how the contaminant enters the body, such as inhalation. The point of exposure is the place where people come in contact with the contaminated medium, which in this case would be the bank of the creek. The source of contamination is used to describe what the contaminants are and where they originate, which in this case would be the chemicals. The environmental medium that the contaminant is in is the creek water.
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Bioavailability is the amount of the contaminant that: A) Is absorbed into the body and becomes available at the site of physiological activity B) Initially escapes a container and becomes available for contact with living organisms C) Is airborne and available for inhalation D) Is waterborne and available for skin contact
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A) Is absorbed into the body and becomes available at the site of physiological activity Ans: A Feedback: Bioavailability is the amount of a substance or contaminant that is absorbed into the body and becomes available at the site of physiological activity.
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The nurse conducts biomonitoring of residents of a community exposed to mercury vapor from a manufacturing facility nearby. Which form of biomonitoring is the method for the purpose of determining exposure to this contaminant? A) Measuring heart rate B) Collecting blood or urine C) Assessing respiratory rate D) Obtaining body weight and composition measures
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B) Collecting blood or urine Ans: B Feedback: Biomonitoring is the process of using medical tests such as blood or urine collection to determine whether a person has been exposed to a contaminant and how much exposure he or she has received. Measuring heart rate, respiratory rate, body weight, and body composition would not be as helpful as for determining exposure to a contaminant as would collecting blood and urine samples.
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The nurse asks a client, "Do you wear the clothes you wear at work to home?" This is an example of which subject on the exposure history? A) Present work B) Past work C) Home/residence D) Concerns
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A) Present work Ans: A Feedback: "Do you wear the clothes you wear at work to home?" is an example of present work on the exposure history, not past work, home/residence, or concerns.
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The nurse applies the nursing process to a case in which a client has been exposed to an environmental contaminant. The nurse considers the question, "Has the exposure pathway been interrupted?" This question would be considered during which phase of the nursing process to examine the impact of the environment on human health? A) Assessment B) Planning C) Intervention D) Evaluation
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D) Evaluation Ans: D Feedback: An evaluation, not assessment or planning, is performed for any intervention to decide whether the intervention has achieved its goals and whether improvements or changes need to be made.
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Which most accurately describes environmental epidemiology? A) Focuses on the amount of a contaminant that is absorbed into the body B) Involves monitoring the results of medical tests to determine whether a person has been exposed to a contaminant C) Focuses on the incidence and prevalence of disease or illness in a population from exposures in their environments D) Involves monitoring the number of adverse effects of chemical, physical, or biological agents on people, animals, and the environment
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C) Focuses on the incidence and prevalence of disease or illness in a population from exposures in their environments Ans: C Feedback: Environmental epidemiology is a field of public health science that focuses on the incidence and prevalence of disease or illness in a population from exposures in their environments. Bioavailability is the amount of a contaminant that is absorbed into the body. Biomonitoring is the process of using medical tests such as blood or urine collection to determine whether a person has been exposed to a contaminant and how much exposure he or she has received. Toxicology is the study of the adverse effects of chemical, physical, or biological agents on people, animals, and the environment.
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The information gained from environmental epidemiologic studies can be very helpful in trying to identify whether an exposure or what particular exposures have made people ill. Major challenges to most environmental epidemiology studies include: (Select all that apply). A) Resource intensive in terms of personnel and money B) Period between exposure and illness can be very short C) Weak ability to identify outbreaks of infectious disease D) Limited availability of data on many contaminants and their effect on people's health E) Time consuming to perform
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A) Resource intensive in terms of personnel and money D) Limited availability of data on many contaminants and their effect on people's health E) Time consuming to perform Ans: A, D, E Feedback: Major challenges to most environmental epidemiology studies include the following: limited availability of data on many contaminants and their effect on health, limited understanding about how exposures to multiple contaminants may sicken people, latency between exposure and illness that can be very long, time-consuming to perform, resource intensive in terms of personnel and money, and inconclusive in determining whether X contaminant caused Y illness.
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Children may be more vulnerable to environmental exposures than adults. There are several factors that increase children's vulnerability. Which factors should be considered with children? (Select all that apply.) A) Their body systems are still rapidly developing. B) They eat less, drink less, and breathe more in proportion to their body size than do adults. C) Their bodies may be less able to break down and excrete contaminants. D) Their behaviors can expose them to more contaminants. E) Their breathing zone is further from the ground.
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A) Their body systems are still rapidly developing. C) Their bodies may be less able to break down and excrete contaminants. D) Their behaviors can expose them to more contaminants. Ans: A, C, D Feedback: Children may be more vulnerable to environmental exposures than are adults. Several factors increase children's vulnerability, including the following. Children's body systems are still rapidly developing. Children eat more, drink more, and breathe more (not less) in proportion to their body size than adults. Children's breathing zone is closer to (not further from) the ground than adults'. Children's bodies may be less able to break down and excrete contaminants. Children's behaviors can expose them to more contaminants.
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Environmental justice is most accurately described as the belief that: A) Those who violate the environment should be required to pay significant fines or face extensive prison sentences. B) All the harms humans have committed against the environment will one day result in divine judgment. C) All people should have equal access to the environment. D) No group should suffer more from environmental health consequences than others.
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D) No group should suffer more from environmental health consequences than others. Ans: D Feedback: Environmental justice is the belief that no group of people should bear a disproportionate share of negative environmental health consequences regardless of race, culture, or income.
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Environmental justice is an important consideration when working with tribal communities. In which way is traditional tribal practices most often directly affected by contaminated land and water? A) Spiritual practices B) Dietary practices C) Work opportunities D) Exercise opportunities
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B) Dietary practices Ans: B Feedback: Tribal communities often bear a disproportionate burden of impact from pollution on their tribal lands. Traditional tribal practices include eating traditional foods for either a majority or a portion of their diets, and contamination of the land or water has a direct effect on food sources.
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In the United States, most citizens have access to clean water and sanitation services and often take these services for granted. Worldwide, however, clean water and sanitation are not standard. How many people worldwide in 2010 lacked access to improved water sources? A) 7 million B) 78 million C) 783 million D) 7.8 billion
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C) 783 million Ans: C Feedback: According to the WHO, in 2010, 783 million people lacked access to improved water sources.
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Changes to water supplies and increased flooding, which are believed to result from climate change, may make some areas more vulnerable to diseases. Which diseases are expected to become more prevalent as a result of climate change? (Select all that apply.) A) Asthma B) Lung cancer C) Diarrhea D) Malaria E) Dengue fever
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A) Asthma C) Diarrhea D) Malaria E) Dengue fever Ans: A, C, D, E Feedback: Changes to water supplies and increased flooding may make some areas more vulnerable to diarrheal diseases. Experts predict that common vector-borne diseases such as malaria and dengue fever will affect larger geographic areas as the vectors that carry the diseases find agreeable climates in expanding areas. Climate change will also affect air quality. The WHO estimates that 300,000 million people have asthma and will face increased disease burden from climate change. There is no association of increased incidence of lung cancer with climate change.
