Community health nursing a canadian perspective 3rd edition by stamler test bank

Community Health Nursing: A Canadian Perspective: 3rd Edition Test Bank – Stamler & Yiu Sample Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 1 Describe four sub-disciplines of epidemiology and give a community health nursing practice example related to each function Describe three areas that Florence Nightingale addressed during the Crimean War that advanced the science of epidemiology Give an example for each area that illustrates the relationship with current community health nursing practice Choose any infectious disease, such as tuberculosis, sexually transmitted infection, influenza, leprosy, etc Apply your chosen disease to the natural history of disease process and describe two interventions that could be done by CHNs in each of the five levels of preventive measures Define three of Timmreck’s criteria of causation Give an example of where a CHN would apply each of the chosen criteria Calculate the odds ratio of developing colorectal cancer related to a low-fibre diet from the following example Write a statement that would explain your results to a client Study group = 300 Risk factor = low-fibre diet Disease = colorectal cancer a) persons with low-fibre diet and colorectal cancer = 100 b) persons with high-fibre diet and colorectal cancer = 20 Total persons with colorectal cancer = 120 c) person with low-fibre diet and no colorectal cancer = 20 d) persons with high-fibre diet and no colorectal cancer = 160 Total persons without colorectal cancer = 180 Identify four criteria that researchers and practitioners use to assess a causal relationship between a stimulus and the occurrence of a disease A public health nurse has been contacted because 12 students living in a college dormitory are ill with bacterial meningitis The cases have been confirmed to be caused by Neisseria meningitidis Using the Venn diagram, describe the environmental characteristics in this scenario and the mode of transmission of this organism Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 What term refers to ―the study of the occurrence and distribution of healthrelated states or events in specified populations‖? a Nosology b Epidemiology c Susceptibility d Biologic plausibility A nurse is working with the school-aged population during the prepathogenesis period What primary prevention activity would promote the health of this population? a Case finding children who may have been exposed to a teacher with hepatitis A b Teaching handwashing and respiratory hygiene c Providing antimicrobials for newly diagnosed contacts d Advocating for testing of sexually transmitted infections (STIs) at a schoolbased clinic 10 A nurse is working with a student nurse and explains that 12% of deaths were from colorectal cancer in 2010 What word is used to describe this type of statistical information? a Crude mortality b Potential years of life lost (PYLL) c Prevalence d Proportional mortality 11 What statistic is used to answer the question, ―How likely is it that I will die from this disease?‖ a Case-fatality rate b Specific mortality rate c Relative risk d Incidence Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 12 Chapter – Case A public health nurse (PHN) is explaining to a fourth-year nursing student how to use health statistics to understand population health (Refer to Case above.) A PHN is comparing the incidence of childhood asthma in a population exposed to a certain air pollutant with the incidence in a population not exposed to that pollutant to determine relative risk The PHN asks the student to select the statistic, which supports that the risk for asthma is greater in the exposed population What is the correct answer? a 1.0 13 Chapter – Case A public health nurse (PHN) is explaining to a fourth-year nursing student how to use health statistics to understand population health (Refer to Case above.) The PHN asks the nursing student to develop some questions for a survey about smoking behaviour Which question would be best at eliciting information on period prevalence? a ―Do you currently smoke?‖ b ―Have you smoked within the last six months?‖ c ―Have you ever smoked?‖ d ―At what age did you start smoking?‖ Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 14 Chapter – Case A public health nurse (PHN) is explaining to a fourth-year nursing student how to use health statistics to understand population health (Refer to Case above.) The nursing student wants to administer a survey about smoking behaviours to students in various grade levels within the school district to identify the best grade to initiate health education A follow-up survey will be administered to assess the effectiveness of the educational program What type of research design would be best at providing the epidemiological information needed in this scenario? a Cross-sectional study b Cohort design c Randomized control trial d Case-control methodology 15 Chapter – Case A public health nurse (PHN) is explaining to a fourth-year nursing student how to use health statistics to understand population health (Refer to Case above.) The PHN asks the nursing student how participant privacy will be managed in the study What strategy presented by the student would be best at meeting this ethical concern? a Data will be used in a confidential manner b The survey will be anonymous c The participants will sign a consent form d Ethics approval will be sought Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 16 A nurse in a large urban centre is working to provide prophylactic agents to exposed vulnerable hosts What action is the best example of this goal? a Providing varicella-zoster immune globin (VZIG) to appropriate children after a classmate is diagnosed with chickenpox b Administering human papilloma virus (HPV) vaccine to girls in grade c Routinely immunizing 1-year-old children for measles, mumps, and rubella d Tuberculosis (TB) testing exposed students at a high school after a student is diagnosed with TB 17 Chapter – Case The public health nurses (PHNs) are busy responding to seasonal influenza in a community of approximately 75 000 people An assisted living facility has an increased number of influenza cases among the residents (Refer to Case above.) A nurse is doing an inservice with the housekeeping staff at the facility about the transmission of the influenza virus Which is an example of indirect transmission via a fomite? a Inhaling a droplet from a sneeze b Shaking a contaminated hand c Drinking tainted water d Touching a contaminated doorknob Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 18 Chapter – Case The public health nurses (PHNs) are busy responding to seasonal influenza in a community of approximately 75 000 people An assisted living facility has an increased number of influenza cases among the residents (Refer to Case above.) The PHNs are trying to protect the residents from the flu What is an example of a primary prevention initiative? a Increasing assessments of the ill to identify complications early b Screening individuals for signs of influenza c Instructing individuals to sneeze into one’s arm d Administering Tamiflu to ill residents 19 Chapter – Case The public health nurses (PHNs) are busy responding to seasonal influenza in a community of approximately 75 000 people An assisted living facility has an increased number of influenza cases among the residents (Refer to Case above.) Family members of the residents have been following FluWatch on the Public Health Agency of Canada web page What type of reporting is FluWatch? a Statistics Canada information b Surveillance data c Health Reports d Reportable disease Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 20 What statement best describes a cohort study? a It focuses on a group of people exposed to a particular health problem or potential stressor over time b The researcher manipulates some of the variables in order to ascertain the effect of the manipulation c The individuals in the group with the disease are matched with individuals who are similar in some characteristics (e.g., age, gender) but who have not manifested the disease in question d Selected variables within a specific population are studied to look for evidence of association and causality 21 What is an example of tertiary prevention of a communicable disease? a Observing clients taking tuberculosis medication b Demonstrating vaccine efficacy rates c Encouraging frequent handwashing during flu season d Immunizing students during a meningitis outbreak 22 What type of research design was used in the Framingham Heart Study? a Case series b Cohort c Cross-sectional d Case-control 23 What agency in Canada is responsible for gathering surveillance data on reportable diseases? a Health Canada b Statistics Canada c Canadian Institutes of Health Information (CIHI) d Public Health Agency of Canada (PHAC) 24 A nurse is concerned about a recent outbreak of measles in a group of migrant workers How would the nurse explain the concept of incidence to a new staff member? a The rate at which new cases occur in a population during a specified period b A measurement of disease frequency c Occurs frequently and with predicted regularity d The proportion of a population that is affected by the disease at a specific time Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 25 What is the purpose of epidemiology? a The study of the occurrence and distribution of health-related states in specified populations b To provide statistics to direct health care funding to the appropriate cause c To predict and control challenges to population health d An area of medicine that deals with the study of the causes of disease in populations 26 Who is believed to be the first person to notice and record the relationship between the environment and health? a Labonte b Nightingale c Epp d Hippocrates 27 Which epidemiological model best allows a nurse to visualize the relationships between various determinants of health? a Causation criteria b Epidemiological triangle c Web of causation d Venn diagram 28 A nurse wants to know the current rate of human papilloma virus (HPV) infection in women aged 25 years as indicated by abnormal Pap smears Which type of research design would be best to answer this question? a Manipulation methodology b Cross-sectional c Prospective cohort d Randomized controlled Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 Activity Name: Chapter 09 – public health epidemiology CHN e.g., monitoring and tracking sexually transmitted infections over time – exposure-oriented epidemiology CHN e.g., studying the effects of a vegetarian diet on the health outcomes of children – disease-oriented epidemiology CHN e.g., studying the distribution of cervical cancer in social districts within a health region – occupational epidemiology CHN e.g., monitoring and tracking asbestos-related illnesses over time in a particular occupational group Learning Objective: Chapter Essay Questions Feedback: Hints: – increased the recording of death statistics CHN e.g., HHN provide information for the completion of the death certificates – used the death statistics to explain and publicize the reality of the horrid situation CHN e.g., CHNs have been very vocal in publicizing the effects and causes of homelessness – used polar diagrams to demonstrate that what was killing the soldiers was contagious diseases CHN e.g., CHNs can use Venn diagrams to illustrate the multiple host/agent/environmental factors influencing heart disease – implemented sanitation practices that proved to authorities that her ideas were correct CHN e.g., CHNs educate people about how HIV is transmitted and correct myths about how it is not transmitted Learning Objective: Chapter Essay Questions Feedback: Hints: Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 10 Sexually transmitted infections Health promotion – health education on human sexuality development – social marketing campaign to promote healthy sexual choices, such as condom use, abstinence, and limited sexual partners – specific protection – accessibility to free condoms and sexual health counselling Early diagnosis and prompt treatment – STI testing at easily accessible free clinics – treatment of STIs and case follow-up to treat contacts Disability limitation – testing of cure after STI treatment for high-risk persons – counselling for people with nontreatable STIs such as herpes Rehabilitation – HIV/AIDS support agencies – HIV/AIDS hospices Learning Objective: Chapter Essay Questions Feedback: Hints: Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 11 See Table 9.1 for more details – consistency CHN e.g., Everyone who drank the contaminated camp water got sick – strength CHN e.g., People who drank the most water got the most sick – specificity CHN e.g., Giardia parasites in the water made people sick with an enteric illness Influenza virus in the water would not make people sick with an enteric illness – time relationship CHN e.g., A person can’t get influenza until after exposure to the virus – congruence (coherence) CHN e.g., Since influenza can be transmitted through mucous membrane exposure, a person whose hands are contaminated with influenza virus and who rubs her eyes with her hands is more likely to get sick than someone does not touch her face with her hands – sensitivity CHN e.g., The greater the discrimination between those who got sick from eating raw meat and those who got sick from eating cooked meat, the greater the sensitivity to the disease being spread through raw meat – biological/medical CHN e.g., A child who plays with a child with chickenpox is more likely to get sick than one who plays with a child who is not sick – plausibility CHN e.g., Research has demonstrated that moderate exercise may be more helpful to prevent cardiac disease – experiments and research CHN e.g., Replicated studies over time add to the weight of evidence that smoking causes lung cancer – analogy factors (transfer of knowledge) CHN e.g., It is reasonable to develop a vaccine for the serotypes of HPV that cause cervical cancer, since other specific viruses have successfully been prevented through vaccination Learning Objective: Chapter Essay Questions Feedback: Hints: Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 12 OR = a/c divided by b/d = ad divided by bc = 100 x 160 divided by 20 x 20 = 40 In this study, people who ate low-fibre diets were 40 times more likely to develop colorectal cancer Learning Objective: Chapter Essay Questions Feedback: Hints: – temporal relationship-A person does not get the disease until after exposure to the cause – strength of association-Exposure to a specific stressor or cause is most likely to bring on the disease – dose-response-Persons who are most exposed to the contaminated food (e.g., ate the most) are the most ill – specificity-The cause is linked to a specific disease (e.g., Mycobacterium tuberculosis does not result in chickenpox) – consistency-Everyone who eats contaminated food gets the illness If other food in another time and place is contaminated with the same bacteria, the same illness occurs – biologic plausibility-Consistent with the biologic/medical knowledge that is known (new discoveries may precede biologic plausibility) – experimental replication-Several studies done by different scientists in different places produce the same or similar results Learning Objective: Chapter Essay Questions Feedback: Hints: Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 13 Venn diagram—Environmental Characteristics Physical—weather (e.g., meningitis typically occurs in late winter or early spring) Biological—microorganism (e.g., Neisseria meningitidis) Social—housing (e.g., young people living in close quarters) Mode of transmission: spread by droplet from mouth and nose usually through coughing, sneezing, or kissing Learning Objective: Chapter Essay Questions Feedback: Hints: b Epidemiology Learning Objective: Chapter Multiple Choice Questions Feedback: Incorrect: Susceptibility is described as vulnerability, which determines the individual host response Incorrect: Biologic plausibility is a causation criterion used to assess a causal relationship between a stimulus and the occurrence of a disease Incorrect: Nosology is a branch of medicine that deals with classification of diseases Correct: This is the definition of epidemiology Hints: Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 14 b Teaching handwashing and respiratory hygiene Learning Objective: Chapter Multiple Choice Questions Feedback: Correct: This is an age-appropriate primary prevention strategy that would promote health during the prepathogenesis period in the natural history of disease Incorrect: Providing antimicrobial medications is a secondary prevention activity Incorrect: Screening is a secondary prevention activity and STI testing would be better suited for the adolescent population Incorrect: Case finding is a tracing activity, which is secondary prevention Hints: 10 d Proportional mortality Learning Objective: Chapter Multiple Choice Questions Feedback: Incorrect: Crude mortality rate is determined by total deaths from any cause in a given year in a population divided by average total population for the same year Incorrect: Prevalence is the number of people with a given disease in a population at one point in time Correct: Proportional mortality is the number of deaths from a specific cause in a given population for a particular time period and is compared with the total number of deaths in that same population and time period Incorrect: Another mortality statistic is PYLL, which has arisen from the assumption that a person who dies early in life has lost greater potential than has a person who dies much later in life Hints: Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 15 11 a Case-fatality rate Learning Objective: Chapter Multiple Choice Questions Feedback: Incorrect: Specific mortality rates compare the number of deaths from a specific cause in a particular subgroup with that whole subgroup (e.g., teenage male deaths from motor vehicle collisions) Correct: The case-fatality rate is calculated by dividing the number of people who die from a disease by the number of people who have the disease, thus answering the proposed question Incorrect: Incidence describes the identification of new cases of a disease in a population over time Incorrect: Relative risk answers the question, ―Are some populations more at risk of or vulnerable to a specific disease than others?‖ Hints: 12 d >1.0 Learning Objective: Chapter Multiple Choice Questions Feedback: Incorrect: The relative risk is less than 1.0 (e.g., 0.05); therefore, the given risk factor is probably not significant for the resulting asthma Incorrect: If the relative risk ratio is Incorrect: If the resulting number is 1.0, it means that both groups have the same risk of the health problem, and most likely the risk factor in question makes little or no difference Correct: If the resulting number is >1.0, it indicates that the risk in the exposed group is higher than the risk in the unexposed group, and the risk factor in question is at least one of the significant risk factors for the problem or disease Hints: Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 16 13 b ―Have you smoked within the last six months?‖ Learning Objective: Chapter Multiple Choice Questions Feedback: Incorrect: This question provides information on point prevalence Correct: This is the best question to obtain information on period prevalence Incorrect: This is an example of getting information on cumulative or lifetime incidence Incorrect: This question does not provide information on period prevalence Hints: 14 a Cross-sectional study Learning Objective: Chapter Multiple Choice Questions Feedback: Correct: Cross-sectional studies provide a snapshot of the present, and this baseline data can be used for planning and implementing interventions or to measure change Incorrect: In case-control studies, the individuals in the group with the disease are matched with individuals who are similar in some characteristics (e.g., age, gender, time, geographic residence) but who have not manifested the disease in question Incorrect: In cohort studies, the researcher examines the individual histories of a group of people manifesting a particular disease to find out what common factors they share and what differences can be discerned Incorrect: In a randomized control design, individuals are assigned randomly either to a group that receives the new treatment or to a group that does not receive the new treatment The latter is known as the control group After a period of time, specific variables are measured in each group and compared Hints: Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 17 15 b The survey will be anonymous Learning Objective: Chapter Multiple Choice Questions Feedback: Incorrect: Consent ensures voluntary participation of the research subject but does not guarantee privacy Incorrect: Ethics approval must be sought for any study where data are collected about or from humans, but this is not a strategy for ensuring participant privacy Incorrect: Data used in a confidential manner is important, but this is not the best option for ensuring participant privacy Correct: An anonymous survey means that the researcher does not know who the participants are and participant privacy is maintained Hints: 16 a Providing varicella-zoster immune globin (VZIG) to appropriate children after a classmate is diagnosed with chickenpox Learning Objective: Chapter Multiple Choice Questions Feedback: Incorrect: Routine immunization is a primary prevention activity completed in the prepathogenesis period prior to exposure to the pathogen Correct: This secondary prevention initiative is used to prevent the disease from occurring in vulnerable populations by developing passive immunity Incorrect: TB testing is a screening activity (secondary prevention) to identify students who have TB, but this activity will not provide protection against the disease Incorrect: This is a primary prevention activity completed prior to the girls being exposed to HPV Hints: Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 18 17 d Touching a contaminated doorknob Learning Objective: Chapter Multiple Choice Questions Feedback: Incorrect: This is an example of direct transmission Incorrect: This is an example of indirect transmission by droplet Incorrect: Although water-borne is a type of indirect transmission, the influenza virus is not transmitted in this fashion Correct: Fomite transmission, also called vehicle-borne transmission, is a common indirect method by which the influenza virus is spread Hints: 18 c Instructing individuals to sneeze into one’s arm Learning Objective: Chapter Multiple Choice Questions Feedback: Incorrect: Screening is a secondary prevention activity Incorrect: Tamiflu is a treatment used to reduce the severity of the symptoms and to speed up recovery time This initiative, according to Figure 9.4, is secondary prevention Correct: Attention to personal hygiene is an example of a primary prevention initiative Incorrect: Completing assessments to identify complications from the flu is a screening activity, which is secondary prevention Hints: Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 19 19 b Surveillance data Learning Objective: Chapter Multiple Choice Questions Feedback: Incorrect: Reportable diseases include diseases that are required to be reported by law, for example, tuberculosis and sexually transmitted infections Seasonal influenza is not a reportable disease Correct: Surveillance data provide information on the incidence of many diseases in the population, such as cancer, heart disease, and liver failure Incorrect: Health Reports is a peer-reviewed journal containing a variety of healthrelated articles Incorrect: Statistics Canada produces data that help Canadians better understand their country-its population, resources, economy, society, and culture Hints: 20 a It focuses on a group of people exposed to a particular health problem or potential stressor over time Learning Objective: Chapter Multiple Choice Questions Feedback: Correct: This describes a prospective cohort study Incorrect: This is the intent of a case series research methodology Incorrect: Case-control studies are designed to compare two groups: one group has the disease and the other group does not Incorrect: This statement explains an experimental study design Hints: Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 20 21 a Observing clients taking tuberculosis medication Learning Objective: Chapter Multiple Choice Questions Feedback: Incorrect: This is a primary prevention activity Incorrect: This initiative is an example of primary prevention Incorrect: Health education is primary prevention Correct: Tertiary prevention includes the treatment of disease as in the directly observed treatment (DOTs) program for tuberculosis Hints: 22 b Cohort Learning Objective: Chapter Multiple Choice Questions Feedback: Incorrect: Cross-sectional studies are a snapshot of the present and may also be called prevalence studies Correct: The Framingham Heart Study was the first cohort study conducted in 1949 Incorrect: The Framingham Heart Study was not a case-control design Incorrect: A case-series research methodology was not used in the Framingham Heart Study Hints: Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 21 23 d Public Health Agency of Canada (PHAC) Learning Objective: Chapter Multiple Choice Questions Feedback: Incorrect: In the past Health Canada filled this role, but now it is done by the PHAC Incorrect: This non-governmental agency does report data from multiple sources but mainly provides information on non-reportable diseases Correct: In the wake of Walkerton and SARS, PHAC was formed to manage surveillance data Incorrect: Statistics Canada does not serve this role Hints: 24 a The rate at which new cases occur in a population during a specified period Learning Objective: Chapter Multiple Choice Questions Feedback: Incorrect: This statement is general and can be applied to both the concept of incidence and prevalence Incorrect: This statement describes the term prevalence Incorrect: A disease that occurs frequently and with predicted regularity within a population is endemic Correct: This is a definition of incidence Hints: Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 22 25 c To predict and control challenges to population health Learning Objective: Chapter Multiple Choice Questions Feedback: Incorrect: This is not the purpose of epidemiology, although health statistics may be used in this manner Correct: The purpose of epidemiology is to describe, explain, predict, and control challenges to population health Incorrect: This is a definition of epidemiology Incorrect: This is another way to define the science of epidemiology Hints: 26 d Hippocrates Learning Objective: Chapter Multiple Choice Questions Feedback: Incorrect: Labonte advanced health promotion as a science in the 1970s Correct: Hippocrates was the first to notice and record a possible relationship between the environment and the health or disease of people Incorrect: Epp wrote the document Achieving Health for All Incorrect: Nightingale was also convinced of the effect of the environment on disease but she was not the first to make this link Hints: Name: Date: Course: Stamler/Yiu: Community Health Nursing: A Canadian Perspective, Third Canadian Edition Test: Chapter 09 23 27 c Web of causation Learning Objective: Chapter Multiple Choice Questions Feedback: Correct: The web of causation looks for causes of today’s health challenges and assesses for the presence or absence of particular determinants of health Incorrect: The emphasis in the Venn diagram is on the interrelatedness of the epidemiologic triangle Incorrect: The triangle contains the elements of host, agent, and environment Incorrect: Causation criteria are used to prove cause and effect of disease Hints: 28 b Cross-sectional Learning Objective: Chapter Multiple Choice Questions Feedback: Incorrect: The nurse is not manipulating any variables, which is needed in an experimental study Incorrect: In this study design the researcher manipulates some of the variables in order to ascertain the effect of the manipulation Incorrect: The researcher examines the individual histories of a group of people manifesting a particular disease to find out what common factors they share and what differences can be discerned Correct: A cross-sectional study, also called a prevalence study, is used to collect baseline data for planning and implementing interventions or to measure change