Chapter 09: Screening Nursing School Test Banks

Chapter 09: Screening
Edelman: Health Promotion Throughout the Life Span, 8th Edition

MULTIPLE CHOICE

1. Which is an example of asymptomatic pathogenesis?
a. Blood pressure of 170/98 experiencing headaches
b. Positive finding on colonoscopy and blood in his or her stool
c. Elevated prostate-specific antigen (PSA)
d. Elevated TSH who is always tired
ANS: C
The primary objective of screening is the detection of a disease in its early stages, to treat it and deter its progression. The screening process is based on the principle that disease is preceded by a period of asymptomatic pathogenesis when risk factors predisposing a person to the pathological condition are building momentum toward manifestation of the disease. Therefore, someone with an elevated PSA without any symptoms is an example of asymptomatic pathogenesis. The other three examples demonstrate manifestation of disease (headaches, blood in stool, and tiredness).

DIF: Cognitive Level: Apply (Application) REF: p. 196

2. An occupational health nurse is planning a cholesterol screening with the employees at the factory. Which of the following would be an advantage of conducting this screening?
a. Allows for the beginning of a multiple test screening process
b. Provides an opportunity for health education
c. Allows for preliminary diagnosis of coronary artery disease
d. Provides the opportunity for a referral to a physician
ANS: B
Screenings create an opportunity for providing health education to a group of individuals who may not otherwise receive it. This allows the nurse to take advantage of a teachable moment with the employees in the factory.

DIF: Cognitive Level: Apply (Application) REF: p. 197

3. Influenza occurs among Americans at a rate of 36 per 100 people annually. Which type of rate is this statement describing?
a. Prevalence rate
b. Incidence rate
c. Morbidity rate
d. Mortality rate
ANS: A
Incidence rate is the rate of a new population problem and estimates the risk of an individual developing the specific disease or condition during a specific period or over a lifetime. Prevalence is the proportion of a given population with the disease or condition at any one point in time. Usually acute conditions are assessed by their incidence (rate of occurrence), whereas chronic conditions are measured by their prevalence (generally existing).

DIF: Cognitive Level: Apply (Application) REF: p. 198

4. A nurse is examining the incidence, prevalence, and mortality rates of colon cancer in the community. Which of the following measures of life is being investigated?
a. Quality adjusted life year (QALY)
b. Quantity of life
c. Disability adjusted life year (DALY)
d. Satisfaction of life
ANS: B
Measures of quantity of life affected by a disease are more readily attainable than quality of life measures. Quantity of life can be measured by using incidence and prevalence rates as well as disease-specific mortality rates.

DIF: Cognitive Level: Apply (Application) REF: p. 199

5. Which represents a disadvantage of screening?
a. Utilization of group screening methods
b. Utilization of multiple test screening
c. Utilization of a test with high specificity
d. Utilization of a test with low sensitivity
ANS: D
Group screening and multiple test screening are advantages of screening programs. A disadvantage of screening occurs when the test is unable to distinguish those who probably have the disease from those who do not. Tests with low sensitivity produce a large number of false-negative tests and leave those screened with a false sense of a healthful state, resulting in them losing the opportunity to receive early treatments that could prevent irreversible damage.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 197 | p. 200

6. The nurse is examining the ability of a phenylketonuria (PKU) screening test to distinguish correctly between newborns who have and who do not have the disease. Which of the following measures of accuracy of the instrument is being evaluated?
a. Sensitivity
b. Specificity
c. Validity
d. Efficacy
ANS: C
Validity is defined as a tests ability to distinguish correctly between diseased and nondiseased individuals.

DIF: Cognitive Level: Apply (Application) REF: p. 199

7. The proportion of people with a condition who correctly test positive when screened is known as:
a. sensitivity.
b. specificity.
c. validity.
d. efficacy.
ANS: A
Sensitivity refers to the proportion of people with a condition who correctly test positive when screened.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 200

8. The Denver Developmental Screening Test (DDST) has been said to have excellent test specificity. What does this statement mean?
a. Rarely identifies children who have developmental delays
b. Rarely identifies children who do not actually have developmental delays
c. Has a large number of false positive results
d. Has a large number of false negative results
ANS: B
Specificity measures a tests ability to recognize negative reactions or nondiseased individuals. A test with excellent specificity will rarely be positive if the disease is not present.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 200

9. A nurse determined the interobserver reliability of a blood pressure reading. Which of the following describes the method that was used by the nurse?
a. Blood pressure readings of 124/82 were obtained two days in a row by two different nurses.
b. Three consecutive blood pressure readings of 124/82 were obtained by the same nurse.
c. Blood pressure readings of 124/82 in the right arm and 124/82 in the left arm were obtained.
d. A blood pressure reading of 124/82 was obtained immediately followed by another blood pressure reading of 147/92.
ANS: A
Reliability is an assessment of the reproducibility of the tests results when different individuals with the same level of skill perform the test during different periods and under different conditions. If the same result emerges when two individuals perform the test, interobserver reliability is shown. Therefore, a client with a blood pressure reading of 124/82 two days in a row by two different nurses is an example of interobserver reliability.

DIF: Cognitive Level: Apply (Application) REF: p. 199

10. A nurse is using a sweat test to screen people for cystic fibrosis. Which of the following results demonstrates poor sensitivity?
a. When 6 out of every 10 sweat tests performed are negative, but the six individuals actually have cystic fibrosis
b. When 6 out of every 10 sweat tests performed are positive, but the six individuals do not actually have cystic fibrosis
c. When 6 out of every 10 sweat tests performed are negative, and the six individuals really do not have cystic fibrosis
d. When 6 out of every 10 sweat tests performed are positive, and the six individuals really do have cystic fibrosis
ANS: A
Sensitivity refers to the proportion of people with a condition who correctly test positive when screened. A test with poor sensitivity will miss individuals with the condition, and there will be a large number of false-negative results; individuals actually have the condition but were told they were disease free. Thus when 6 out of every 10 sweat tests performed are negative but the six individuals actually have cystic fibrosis, it is an example of poor sensitivity.

DIF: Cognitive Level: Apply (Application) REF: p. 200

11. A nurse is creating a hypertension screening program. Which of the following methods would be the best way to design a successful program?
a. Work with stakeholders to conduct a community assessment.
b. Purchase state-of-the-art sphygmomanometers to measure blood pressures.
c. Use the program developed at a previous place of employment.
d. Contact a local church to see if the program can be implemented there.
ANS: A
Partnerships are essential to developing health programs and screening programs. The primary rule is to never assume that what is appropriate and effective for one community will be appropriate and effective for another community. A community assessment conducted as a partnership with key stakeholders provides information about the high-risk population, available health care resources, and the high-risk populations health needs. By conducting the assessment, the nurse can identify the necessary community resources and mobilize them to achieve maximal benefits and positive outcomes.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 201

12. A nurse is planning to offer a depression screening at a local community center. Which of the following should be considered prior to implementation of the program?
a. Limited referral sources in the community
b. Limited support groups in the community
c. Insufficient evidence that depression screening tools are cost effective
d. Insufficient evidence mental health screening is appropriate
ANS: A
Constraints affecting the operation of a screening program include financial concerns, political issues, cultural constraints, follow-up and referral services, and accessible treatment facilities. An efficient referral system should link the follow-up resources to the screening program, providing continuity of care. A method must be devised to encourage the participant to take positive action on the referral. Depression screening for adults is a covered preventive service for adults.

DIF: Cognitive Level: Apply (Application) REF: p. 201

13. A nurse is implementing a test that screens for hypercholesterolemia. Which of the following parameters should this test have?
a. No cutoff point
b. Low cutoff point
c. Intermediate cutoff point
d. High cutoff point
ANS: B
The goal of a screening program, identifying an individual as high risk or not, depends on the numerical value of the screening instrument. When the parameter for this distinction is not clear, a cutoff point is set. Above this point, the person is considered disease positive; below this point, the individual is considered disease negative. Thus, if the disease were potentially life-threatening or if a disease is relatively benign in terms of stigmatization, anxiety, and problems with treatment, the lower cutoff would be preferred. High cholesterol, if left untreated, could contribute to life-threatening cardiac disease. Additionally, it is benign in terms of stigmatization. Therefore, a lower cutoff point should be set.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 203

14. During a screening, a test with a high specificity and low sensitivity is utilized. Which of the following issues could arise by using this test?
a. Ethical issues
b. Race issues
c. Gender issues
d. Cultural issues
ANS: A
Misinterpretation caused by screening instruments is of great ethical concern. A difficult ethical issue in screening is determining whether the benefits received by those who receive correct results are worth the problems experienced by those who receive incorrect results. In this case, the high specificity of the test would result in low false-positive rates and would correctly identify nondiseased individuals. However, the low sensitivity would result in a high false-negative rate and therefore would miss a large number of people who are actually positive, resulting in ethical issues.

DIF: Cognitive Level: Apply (Application) REF: p. 200 | p. 202 | p. 203

15. A nurse is educating a group of community members about how hypertension screening is effective in reducing the rate of cardiovascular disease, thus reducing the expenses that are spent on management of this disease. Which of the following ratios is being described?
a. Cost-disease analysis
b. Cost-efficiency analysis
c. Cost-benefit ratio analysis
d. Cost-effectiveness analysis
ANS: C
Cost-benefit ratio analysis allows the comparison of various outcomes in monetary terms. The cost of the screening versus the cost of chronic care management is considered.

DIF: Cognitive Level: Apply (Application) REF: pp. 203-204

16. Which of the following analyses is used to determine the optimal use of resources to reach a predetermined constant end point or the desired health outcome?
a. Cost-benefit ratio analysis
b. Cost-effectiveness analysis
c. Cost-efficiency analysis
d. Cost-disease analysis
ANS: B
An analysis that determines the optimal use of resources to reach a predetermined, constant end-point or the desired health outcome is known as cost-effectiveness analysis.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 204

17. Which of the following is an example of a screenable population for hypertension?
a. High school students
b. Professional hockey players
c. High-level business executives attending an annual conference
d. Cardiac rehabilitation clients
ANS: C
The objective of identifying a screenable population is to identify a high-risk group that, when tested, will yield a significant number of diseased individuals. The main criterion used to define an appropriate population is the definitive presence of risk factors related to the disorder. Most high-level business executives are middle-aged men with stressful jobs, placing them at high risk for heart disease. Thus, this would be the best example of a screenable population for hypertension.

DIF: Cognitive Level: Analyze (Analysis) REF: pp. 204-205

18. A nurse is assessing a low-income population in a community. Which of the following would be most appropriate for this population?
a. HIV screening
b. Blood pressure screening
c. Colorectal cancer screening
d. Breast cancer mammography screening
ANS: B
According to a 2010 Gallup poll, Low-income Americans are more likely than their high-income counterparts to say they have been diagnosed with each of the chronic conditions . . . . the differences are largest for depression, high blood pressure, and diabetes . . . the high level of obesity among low-income Americans is likely a contributing factor in these differences.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 205

19. A nurse is working at a womens health clinic and is asked by a client when she should return for her next Pap smear. Which of the following resources would the nurse use to find the most current recommendations?
a. National Health Information Center
b. Healthy People 2020
c. U.S. Preventive Services Task Force (USPSTF) website
d. Centers for Disease Control and Prevention (CDC) website
ANS: C
The most current information about recommendations for screening tests can be found on the Agency for Healthcare Research and Quality (AHRQ) U.S. Preventive Services Task Force (USPSTF) website. These recommendations evolve as new scientific evidence becomes available.

DIF: Cognitive Level: Apply (Application) REF: p. 206

20. A nurse is educating a 26-year-old, sexually active, female client about the screening tests that are now covered without a copayment or co-insurance because of the Affordable Care Act. Which of the following preventive services would the nurse include in this discussion?
a. Tobacco use screening
b. HIV screening
c. Cervical cancer screening
d. Breast cancer mammography screening
ANS: B
One result of the Affordable Care Act that was passed in 2010 was the movement toward prevention and health promotion. One result is that preventive services are required to be covered by new health insurance plans or policies. When covered by a network provider, HIV screening must be provided by insurance plans without copayment or co-insurance.

DIF: Cognitive Level: Apply (Application)
REF: p. 206 | p. 207 (Box 9-5) | p. 208 (Box 9-6)

21. A nurse is planning a comprehensive health promotion activity to provide community members with a better opportunity to manage their own risk. Which of the following activities would be most appropriate for the nurse to perform?
a. Obtaining blood pressures and cholesterol levels during a screening
b. Obtaining blood pressures and family histories during a screening
c. Obtaining blood pressures and discussing the importance of exercise during a screening
d. Obtaining blood pressures, cholesterol levels, and glucose levels during a screening
ANS: C
Providing health education during a screening falls under the Scope and Standards of Nursing Practice. Many chronic diseases are the result of health behaviors. The nurses role as educator is essential in the screening process because nurses provide individuals with the information necessary for choices that are made regarding healthy behavioral changes. Awareness is the first step in prevention. If awareness is combined with health education and health-promotion tools, people will have a better opportunity to manage their own risks. Thus, obtaining a persons blood pressure while discussing the importance of exercise during a blood pressure screening is an example of a comprehensive health promotion activity.

DIF: Cognitive Level: Apply (Application) REF: p. 209

22. To screen for colorectal cancer, colonoscopy should be conducted every 10 years beginning at age:
a. 30.
b. 40.
c. 50.
d. 60.
ANS: C
It is recommended that men and women age 50 and older have a colonoscopy performed every 10 years to screen for colorectal cancer.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 207 (Box 9-5)

23. For which of the following is Type 2 diabetes mellitus screening recommended?
a. Overweight woman
b. Teenager
c. Man with hypertension
d. Woman with a family history of Type 2 diabetes mellitus
ANS: C
The risk of developing Type 2 diabetes mellitus increases with age, obesity, and lack of exercise. Although the woman with a family history of Type 2 diabetes mellitus is at risk of developing the disease, screening is only recommended for those with hypertension. Therefore, the man with hypertension should be screened for Type 2 diabetes mellitus.

DIF: Cognitive Level: Apply (Application) REF: p. 207 (Box 9-5)

24. Which of the following women should be screened for breast cancer?
a. A 35-year old woman with three children and no family history of breast cancer
b. A 59-year-old woman with no children who still gets her period every month
c. A 25-year-old woman with one child whom she gave birth to when she was a teenager
d. A 17-year-old woman with one child who started menstruating at the age of 13
ANS: B
In the United States, the incidence of breast cancer increases with age. Breast cancer mammography screenings are recommended every 1 to 2 years for women over 40.

DIF: Cognitive Level: Apply (Application) REF: p. 208 (Box 9-6)

25. A nurse is speaking to a womens group in the community about the importance of completing mammography to screen for breast cancer. At which age should the nurse recommend that mammography begin?
a. 18
b. 21
c. 35
d. 40
ANS: D
It is recommended that all women age 40 and older have a mammography performed every 1 to 2 years to screen for breast cancer.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 208 (Box 9-6)

26. A nurse is reviewing the chart of a 15-year-old girl who has been sexually active since the age of 12. Which of the following findings would be of most concern?
a. She does not perform self-breast exams.
b. She has never had a Pap test.
c. She had one HIV test performed at the age of 13.
d. She does not use birth control pills.
ANS: B
Although self-breast exams are encouraged and considered an important aspect of breast health education, data regarding its efficacy is weak. Although she does not use birth control pills, there is no indication that she does not use other forms of birth control such as condoms that would also prevent against STDs. There is also no indication that she has had more than one sex partner and is at high risk for HIV infection. A cervical dysplasia screening is recommended for sexual active females. Therefore, the fact that she never had a Pap test to screen for cervical cancer and has been sexually active for the last 3 years is concerning.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 208 (Box 9-7)

MULTIPLE RESPONSE

1. Which of the following is an example of screening? (select all that apply)
a. Asking if someone performs self-breast exam
b. Performing a self-breast exam
c. Obtaining a mammogram
d. Undergoing a needle biopsy
ANS: B, C
Screening is not considered a diagnostic measure. The ultimate goal could be curative, but more often, it is to prevent further development of the condition or disease. Screenings are done by oneself, or can be clinical, procedural, or lab based. Performing a self-breast exam and obtaining a mammogram are examples of screening. Asking if someone performs a self-breast exam may increase awareness but does not screen for disease. A needle biopsy would be diagnostic.

DIF: Cognitive Level: Apply (Application) REF: p. 196

2. A nurse is assessing a community and is trying to determine the appropriateness of conducting a Type 2 diabetes screening in the community. Which of the following questions would the nurse need to answer when making this decision? (select all that apply)
a. Is Type 2 diabetes considered a community problem?
b. What are the health benefits of screening for Type 2 diabetes?
c. Can Type 2 diabetes be detected by screening?
d. What is the cost-benefit ratio of implementing this screening?
ANS: A, B, C
The answers to the following three questions provide a basis for designating a disease as screenable or not screenable: Does the significance of the disorder warrant its consideration as a community problem? Can the disease by detected by screening? Should screening for the disease be done?

DIF: Cognitive Level: Apply (Application) REF: p. 198

Leave a Reply